Modelling the impact of increasing tuberculosis treatment coverage and addressing determinants of risk in men

BACKGROUND: Globally, the burden of tuberculosis falls more on men than women and children, and there are large gaps between men and women at all stages of exposure, disease incidence, and treatment. We examined the impact of addressing determinants of these gender gaps in Kenya, Malawi, Nigeria, and Uganda. METHODS: We created a deterministic transmission model of tuberculosis, calibrated to country-specific data on prevalence, incidence, mortality, and notifications between 2010 and 2022. We examined the potential epidemiological impact of strategies to increase treatment coverage among men and decrease the effects of social and structural determinants that increase men's risk of developing TB. We investigated the impact (overall and by age and sex) on projected incidence and mortality in 2035, and notification rates between 2025 and 2030. RESULTS: Our modelling estimates that increasing treatment coverage among men could reduce incidence in 2035 between 2.4% [95% uncertainty interval (UI) 0.2-6.0%] in Malawi and 23.0% [UI 16.8-29.3%] in Nigeria. Reducing men's excess risk of tuberculosis could similarly reduce incidence in 2035 between 9.8% [UI 7.5-12.6%] in Malawi and 30.1% [UI 24.1-40.5%] in Kenya. Impacts extend across the population with median estimates of country-level declines in incidence of between 0.9-17.8% and 1.4-22.2% in women and children, respectively, across the four countries. CONCLUSIONS: Strategies that prioritise increasing tuberculosis treatment coverage among men and mitigating men's higher susceptibility to tuberculosis could reduce disease burden for men, women, and children. Such gender-responsive strategies are essential to ensure a person-centred tuberculosis response and accelerate global progress towards the EndTB targets.